• 2013
  • 2013

December 2013 | First report on successful management of delayed presentation of Boerhaave´s syndrome

Current guidance has advocated surgery for delayed presentations of Boerhaave´s syndrome with evidence of mediastinal contamination. However, Dr. Eamon Ramhamadany and colleagues, Dept. of General Surgery, University Hospital Coventry and Warwickshire, UK, present the successful management of Boerhaave´s syndrome in a 69-year-old man by means of the OTSC System, sparing the patient surgery and possible associated complications. The man presented to hospital with an episode of forceful vomiting. A chest radiograph was performed revealing a pleural effusion. After several days without improvement a CT chest showed an oesophageal perforation with mediastinitis. Because of the size of the defect and the delay in presentation, it was decided not to perform surgery, but to apply the OTSC clip for endoscopic repair. A contrast swallow confirmed the correct placement of the clip and the successful closure of the leak. After a total parenteral nutrition for 3 days, the patient was fed via a naso-jejunal tube. Intravenous antibiotics and bilateral chest drains led to a resolving mediastinitis. The whole procedure resulted in a favourable outcome without the need for surgery. The authors conclude that the OTSC can be used to manage patients with delayed presentation of Boerhaave´s and that further evaluation is needed to define the indications for minimally invasive techniques like the OTSC System. 

A delayed presentation of Boerhaave's syndrome with mediastinitis managed using the over-the-scope clip.
Ramhamadany E, Mohamed S, Jaunoo S,  Baker T, Mannath J, Harding J, Menon V
J. surg. case rep. (2013) 2013 (5): rjt020. 
doi: 10.1093/jscr/rjt020